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Individual

DR. KELLY GAIL KINNAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1700 HIGHWAY 25 N, BUFFALO, MN 55313-1930
(763) 682-1313
Mailing address
1700 HIGHWAY 25 N, BUFFALO, MN 55313-1930
(763) 682-1313

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
47793
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080016114
MEDICARE-WPS
MN
01
094H0SW
BCBS OF MN
MN
01
1014268
PREFERRED ONE
MN
05
176473000
MN
01
2435604
AMERICA'S PPO
MN
01
6609467
MEDICA UC# FOR APC
MN
01
HP61506
HEALTHPARTNERS
MN
Enumeration date
05/16/2006
Last updated
09/29/2008
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